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What does 2018 hold for General Practice?

Even as a profession used to dealing with uncertainty, GPs have had to cope with a barrage of changes in recent years and 2018 is unlikely to be any different.

Here are some of the issues that are likely to dominate the profession this year.

Workforce

Recruitment will continue to be a problem as younger GPs choose more flexible careers, increasingly as locums, rather than taking a permanent practice role.

At the other end of the scale, many older GPs are choosing early retirement no doubt spurred on by the relentless pace of change.

Plans are in place to tackle the issue but time alone will tell if they are far ranging enough.

In addition to Health Education England's intention to train over 15,000 GPs by 2020, the NHS plans to bring in international doctors and offer "golden hellos" for newly qualified GPs starting their career in areas that struggle to attract family doctors.

Is this enough? Figures released in late November by NHS digital showed a fall in the number of GPs and there are over 2,100 GPs in the UK from EU countries who may be affected by Brexit.

Health pressures

A workforce shortage can also lead to burnout for those covering the gap - especially when those people are also facing longer working hours to meet the Government's calls for a seven-day NHS.

Our own research shows that mental health issues are one of the major causes of claims for GPs.

Although NHS England launched a free, confidential service to provide mental health support to doctors earlier this year, more needs to be done.

Rising wages

Jeremy Hunt recently announced the NHS pay cap had been scrapped after a seven-year freeze, but he hasn't indicated how big any rise might be or indeed if any extra funding will be allocated to the NHS to cover the cost.

GPs were largely overlooked in the Autumn budget and while the NHS was given £2.8bn extra funding, most in the profession don't believe this will be sufficient to maintain standards.

Although anyone claiming their NHS pension will see it rise in line with inflation, this is small comfort for working GPs who are seeing the value of the pound in their pocket fall thanks to rising inflation.

Indemnity Support

The Health secretary has also revealed that a state-backed scheme for clinical negligence indemnity for general practice could go ahead from April 2019.

This is good news for the profession, as rising indemnity costs are having a serious impact on general practice pushing thousands of GPs to reduce the sessions they work or quit the profession altogether.

Details of how the state backed scheme will look are still unclear and it could be 12 to 18 months until it is developed, although it seems unlikely to cover non-NHS work so GPs may need to take out additional indemnity cover.

New technology is also offering developments in patient care - such as 24-hour GP consultations via video link, as is available in London.

The implementation of any new tech needs to be managed in the best interests of patients and the broader NHS. The Royal College of GPs has warned about issues such as the threat of back-door privatisation of primary care and cherry-picking of healthy patients.

New models of care

Like many professions, GPs are having to adjust to working in new ways. Small practices are increasingly joining forces with larger ones to provide scale and offer more co-ordinated services

Vanguards and Sustainability and Transformation Plans (STPs) have drawn up location-based plans across multiple agencies to improve health, care quality and efficiency of local services.

They bring different parts of the NHS and social care system together in a particular location to provide more co-ordinated services to patients - for example, by GPsworking more closely with hospital specialists, district nurses and social workers to improve care for people with long-term conditions.

In 2018, steps will be made to form Accountable Care Organisations (ACOs) from the STPs, which will further embed local decision-making by health and social care partners in patients' best interests.

Conclusion

It seems unlikely that 2018 will bring any respite for general practice from the constant flow of change seen over the past few years.

What we can hope is that the new ways of working that emerge over the next 12 months will help to ease some of the pressure.